HomeMy WebLinkAboutBuilding Permit #188 - 299 MIDDLESEX STREET 9/12/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION o`t`4ORIy
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Penn it NO: F Date Received - '- � 4 :T ,
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Date Issued: �9SSACHUS�t
C IMPORTANT: Applicant must complete all items on this page
LOCATION �l / /v S/ ° JV 41 6��A—
Print
PROPERTY OWNER/0'79 Z67�,e
Frifit
MAP NO. PARCELsJ ZONING DISTRICT:
- 7
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
E New Building a One family
❑ Addition -Two or more family -i Industrial
n Alteration No. of units:
epair, replacement ❑ Assessory Bldg C Commercial
Demolition
Moving(relocation) ❑Other _ 0
thers:
i] Foundation only
DESCRIP IO OF WO B PREFORMED-
112 z
Identification Please Type or Print Clearly) �c,.p� /1 /J
OWNER: Name:�Qr/c1 714 Phone f/ n��T
Address:9 MIV611 S7—,—, C/�G
CONTRACTOR Name: / / {" �/' Phone:
Address: AAW 11- M 517—,
Supervisor's Construction License: Exp. Date:
Home Improvement License: / � Exp. Date: 7��3 �t7
ARCHITECT//ENGINEER- `/� Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.,872.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED 17- 0 PU S.F.
Total Project Cost :$ FEE:$ � �-�--
3�a
Check No.: Receipt No.:
Pae loF4
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be
obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
a Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ Building Permit Application
❑ Surveyed Plot Plan
a Workers Comp Affidavit
a Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the
Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds.
One copy and proof of recording must be submitted with the building application
Doc:INSPECTIONAL til{KV(CEti DISP.�K'1'�IIiN'I':BPPOR\1115
Poo .J nf.l
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art I Swimming Pools Ej
Public Sewer
Well Tobacco Sales ❑ Food Packaging/Sales ❑
n Permanent Dumpster on Site !_�
Private(septic tank,etc. Electric Meter location to
project
NOTE: Persons contracting with unregiste d contractors do not have access to theguaranty fin
0 ;4��
Signature of. gen Owner Signature of contracto
Plans Submitted F] Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
` DATE REJECTED DATE APPROVED
+ HEALTH ❑ ❑ - -- -
i
COMMENTS
Zoning Board of Appeals: Variance, Petition No: j
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer connection/Signature& Date Driveway Permit
Temp Dumpster on site yes '_io Fire Department signature/date
- — 1
Building Setback(ft.)
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area,based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA–(For department use)
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Doc:INSPEC rIONAL SFRVICES DEPARTMENT:I311FORM05
Crealed.IblC.Jan.2006
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No. Date �• �' "��
40RT1y TOWN OF NORTH ANDOVER
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=: + + •
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t<�' Building/Frame Permit Fee $
AC NUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
F.
19567
N-3 Building Inspector
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Construction Artisans, Inc. Tel. 978-821 -4432
Remodeling and. Building with Perfection
Estimate/Invoice for Home or Office Repairs and Improvements
Last Name Gisetto Home# 978-A-4481 Date
First Name Scott and Lori Lori cell 978-852-3551 9/7/2006
Street 299 Middlesex St. Cell# 781-883-4450 Scott's cell Job#,1
City, State N. Andover Zip Code 1 01845 Cust.V 63
Scope of Protect
Kitchen remodel, relocate Washer/Dryer
Itemized Project Description(s) Materials Labor
File all permit applications and submit framing plans and floor plans.
Permit filing fees and meet with inspectors during "rough" and "finals."
Move all existing appliances to other areas.
Hang plastic/drop clothes to minimize dust during demo. Cover furniture.
Demo walls and ceiling to studs.
Demo includes entire pantry area and back room near kitchen.
Open entry way to pantry. Install header flush with ceiling.
Build wall and door opening in back room.
Frame second wall along outside wall for plumbing for Washer. Add a door.
Frame walls around chimney. Add bricks to block hole.
Demo old wiring, water pipes and gas pipes.
Wire per code. Ron Record to perform all Electrical work per his estimate.
Cost of Electrical work is estimated at$4,000.
Electrical fixtures not included except for recessed lights.
If upgrade to 200 Amp service is required then cost is estimated at$1,800.
Electrical work includes lighting, switches, outlets, Washer and Dryer plugs.
Any unforeseen conditions or wiring not per code will be brought up to code
in order to pass inspections. Additional cost will apply.
Rough plumb H and C supply lines and all PVC vents and drains.
Plumb for new sink in galley kitchen, gas stove, and washer.
Vent dryer to outside.
Plumbing work is estimated at$4,500. Any unforeseen conditions, code
violations or repairs that may need to be made will be an additional expense.
Meet with Electrical, Plumbing and Building inspectors for"rough" inspect.
Insulate walls with R-13 and ceiling with R-30. Insulate around chimney with
Fired rated insulation. .
Hang blueboard then skim coat plaster walls and ceilings all smooth
Sand walls and ceiling then prime. Paint walls 1 coat of Benjamin Moore.
Sand floors and repair as needed.
Install all cabinets and appliances.
Install window trim, door trim and baseboard. Paint trim 2 coats. Paint doors.
Cabinets to be delivered by Supplier to customer.
Countertops to be delivered and installed by supplier.
All appliances to be furnished by homeowner and delivered by supplier.
Contractor to install cabinets but not countertops.
Plumber to make final connections for Sink and Washer.
Electrician to finalize lights, switches, outlets, stove, micro, washer and dryer.
Contractor to meet with Inspectors for"final" inspections.
Any changes to this estimate during the progression of work will be discussed
and a change order will be provided to the owners.
Materials and Supplies:
Materials Selection, pick-up and delivery. Included
Debris Removal and Disposal Fees Included
Permits and Inspection Fees (est. _ $400) Included
Contractor supplied material allowance = $2,500. Included
Homeowners agree to reimburse contractor for all job related materials.
Payments: Deposit of 40% ($10,000) prior to start, 2nd Total Materials $3,975.00
payment of 30% ($8,000)when ready for"rough"
inspections, 3rd payment of 20% ($5,000) after
blueboard, plaster, flooring and paint, then final
payment of 10% ($3,875) upon completion. Total Labor
$22,900.00
Total Due: $26,875.00
Customer SignatureDate14�11 1012-1-
Mike 27 Kilmarnock St.Wilmington, MA 01887
Cic##082711 0
MA Builderss Lic
Home Impr.Reg#143724 Office Hours: 7:OOAM -7:OO.PM Monday thru Sunday
Email: Mike@ConstructionArtisans.com Web:www.ConstructionArtisans.com FEIN # 20-0706881
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Construction Artisans, Inc.
Remodeling and Building with Perfection
27 Kilmarnock St
Wilmington,MA 01887 Mike Loranger, Pres-.
MA Builders Lic#082711
Home Impr.Reg#143724 I
g
Tel:
Full Insured(Liability Fully � h&WC) Mike@ConstructionArtisans.com
www.Constr-uctionArtisans.com
� ✓!ze iiJoon�rrzoavureal� 0�✓l'(.a:�ac�trael�6
_ Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 143724
Expiration: 7/23/2008
Type: Private Corporation
CONSTRUCTION ARTISAN, INC.
MICHAEL LORANGER
27 KILMARCK ST
WILMINGTON,MA 01887 Deputy Administrator
J
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BOARD OF BUILDING REGULATIONS �,-'.
License: CONSTRUCTION SUPERVISOR
Number: CS 082711
\a Birthdate: 11/05/1956 `
Expires: 11/05/2007 Tr.no: 9177.0
'u Restricted: 00
MICHAEL P LORANGER
:" 27 KILMARNOCK ST
WILMINGTON, MA 01887 _ t
Commissioner
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SUMMARY-_0F INSUIRANCE ' :.l Prepared: 05/12/06 _ Page 1
For: Construction Artisians,Inc Wilmington Insurance Agency
Mike Loranger Five Middlesex Avenue Unit 14
27 Kilmarnock Street _. P.0.Box 1010
Wilmington,MA - Wilmington,MA
01887 978-821-4432 01887-0580 978-6583805
Coverage Amount Company Policy No Eff Exp Premium
Workers Compensation Granite State Insurance Co WC2313772 05/07/06 05/07/07
Named States: MA
Employer's Liability
Each Accident 500,000
Disease-Policy Limit 500,000
Disease-Each Employee 500,000
Additional Coverage/Endorsements
I
General Liability Western Heritage SCP0511831 05/03/06 05/03/07
Occurrence
General Aggregate 2,000,000
Products/Completed Oper.Aggr. 2,000,000
Personal&Advertising Injury 1,000,000
Each Occurrence 1,000,000
Damage to Rented Premises 300,000
Medical Expense(Any One Person) 10,000
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The iCommonwealth of Massachusetts
Department of Industrial Accidents
r
Office of Investigations
UIP,
600 Washington Street
Boston, MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): 71r o
ho
Address:j 7
i
City/State/Zip: / / / Phone
A e ou an employer?Check the appropriate box: Type of project(required):
1. m a employer with 4. El am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. K-1
emodeling
ship and have no employees These sub-contractors have 8. Demolition
workingfor me in an capacity. workers' comp. insurance.
y9. F] Building addition
[No,workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their
10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.] t employees. [No workers'
13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Nam612 f 7 ` 's
Policy#or Self-ins.Lic. #: Expiration Date: c5
Y
Job Site Addres,-�, f 0tfir 177 City/State/Zip:AeAAq� � Q��✓�j
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify undeer t e p i enalties of perjury that the information provided above 's true and correct. -
Si nature: Date: 9 1
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the e event the Office of Investigations Y est ations h
g as to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-$77-MASSAFE
Revised 5-26-05
Fax#617-727-7749
www.mass.gov/dia
NORTH
Town of
No.
dower Mass. Z d
T Q -_ LA E 1
C OC MIC ME WICK V
Q�'4ATED
`S BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
� BUILDING INSPECTOR
THIS CERTIFIES THAT...... .�............ ...... ... ...... !!....... ....................................... Foundation
has permission to erect........... ............................;U#41
s on .. ...... � � ...•....4S ...• Rough
to be occupied as .. ..I.� . o...*.AA..•................................................................... Chimney
provided that the p son accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
3 z z PERMIT EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRUCT TS Rough
. .......... ....... ............... Service
BUILDING
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.